Wiki Observation Question

[bdennis]

The observation order was placed on day 1, but it was late in the day and the provider did not see the Medicare patient. On day 2 the provider saw the patient, is this an initial observation or subsequent observation? Does Medicare have something in writing?

For the same day admit/discharge, is the admit date the date the order was written or is it the date of the initial visit? Example: The observation order was placed on day 1, but it was late in the day and the provider did not see the Medicare patient. On day 2 the provider saw the patient in the morning and then came back and discharged the patient later in the day, is this a same day admit discharge? Any idea where I can get documentation to support this?

 

[thomas7331]

Observation always begins at the time that the order is written. Normally the admitting physician needs to evaluate the patient prior to writing the order (although the dictation/documentation might not be completed until later), otherwise how does the physician make the determination that observation status is necessary or appropriate? I'm not sure why you'd be seeing an initial visit on the next day. Just my thoughts here, but if I were coding in this situation, I would consider the initial visit documentation to be missing, and would treat the services on the following day as discharge day management and not give any credit for an initial. I would not code it as a same day admit/discharge because then your physician service code will not match the hospital's patient status in the record which has to go by the time of the order.

 

[wkpotter6]

Hello, I work for a practice with Residents and Fellows. Scenario: A resident/fellow see the patient and start the admit order at 10PM yet the admitting physician does not see them until 7AM the next day and then discharges the patient at 4PM that day. H&P note and DC note are same day just not technically the same day as the resident/fellow order. How would this be billed? With the the resident/fellow's admit order, is admit that day or the next day when the admitting physician completes the admit order? Thank you